Centimeter ruler (flexible, clear)
Flashlight with transilluminator
Wood’s lamp (to view fluorescing lesions)
Handheld magnifying lens (optional)
Cutaneous Color Changes
|Pigmented nevi. Nonpigmented striae. Freckles. Birthmarks.|
|UNEXPECTED:Dysplastic, precancerous, or cancerous nevi. Chloasma. Unpigmented skin. Generalized or localized color changes. Vascular skin lesions. Vascular changes.|
|EXPECTED:Thickness variations, with eyelids thinnest, areas of rubbing thickest. Calluses on hands and feet.|
|UNEXPECTED:Atrophy. Hyperkeratosis. Corns.|
|EXPECTED:Minimal perspiration or oiliness. Increased perspiration (associated with activity, environment, obesity, anxiety, excitement) noticeable on palms, scalp, forehead, axillae.|
|UNEXPECTED:Damp intertriginous areas.|
Palpate with dorsal surface of hand or fingers.
|EXPECTED:Cool to warm. Bilateral symmetry.|
|EXPECTED:Smooth, soft, and even. Roughness resulting from heavy clothing, cold weather, or soap.|
|UNEXPECTED:Extensive or widespread roughness.|
|Turgor and mobility|
|Gently pinch skin on forearm or in sternal area, and release.|
|UNEXPECTED:Failure of skin to return to place quickly.|
|Inspect and palpate lesions|
Measure all dimensions.
Use Wood’s lamp to distinguish fluorescing lesions.
Transilluminate to determine presence of fluid.
Note color, odor, amount, and consistency of lesion.
Check lesion for annular, grouped, linear, arciform, or diffuse arrangement.
Check lesion for generalized/localized, body region, patterns, or discrete/confluent.
|UNEXPECTED:See table on pp. 36–39|
Primary Skin Lesions
|Flat, circumscribed area that is a change in skin color; less than 1 cm in diameter|
|Freckles, flat moles (nevi), petechiae, measles, scarlet fever|
Measles. From Habif, 2004.
|Elevated, firm, circumscribed area less than 1 cm in diameter|
|Wart (verruca), elevated moles, lichen planus|
Lichen planus. From Weston et al, 1996.
|Flat, nonpalpable, irregular-shaped macule more than 1 cm in diameter|
|Vitiligo, port-wine stains, mongolian spots, café au lait spots|
Vitiligo. From Weston et al, 1991.
|Elevated, firm, and rough lesion with flat top surface greater than 1 cm in diameter|
|Psoriasis, seborrheic and actinic keratoses|
Plaque. From Habif, 2004.
|Elevated irregular-shaped area of cutaneous edema; solid, transient; variable diameter|
|Insect bites, urticaria, allergic reaction|
Wheal. From Farrar et al, 1992.
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